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<h1 class="p_Heading1"><span class="f_Heading1">Custom Lists by HIV Care Static Forms</span></h1>

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<p> (A=add terms; I=Inactivate terms; U=updated terms)</p>
<p>&nbsp;</p>
<p>See <a href="restricted_and_unrestricted_lists.htm" class="topiclink">Restricted and Unrestricted Lists</a> for more information.</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="width:644px; border:none; border-spacing:0px; border-collapse:collapse;">
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; background-color:#e0e0e0; padding:4px; border:solid 1px #000000;"><p><span style="font-weight: bold;">List Type</span></p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; background-color:#e0e0e0; padding:4px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Action Allowed</span></p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; background-color:#e0e0e0; padding:4px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Form/</span></p>
<p><span style="font-weight: bold;">Display Type</span></p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; background-color:#e0e0e0; padding:4px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Select List Name on Form</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Enrollment</p>
<p>Multi select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>Potential Barriers to Enrollment Successful HIV Care</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Enrollment</p>
<p>Multi select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>HIV/AIDS Care Types</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:34px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:34px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:34px; padding:4px; border:solid 1px #000000;"><p>Enrollment</p>
<p>Multi select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:34px; padding:4px; border:solid 1px #000000;"><p>ART Sponsor</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Enrollment</p>
<p>Multi select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>HIV Disclosure Status</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Enrollment</p>
<p>Multi select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>Barriers to HIV Care</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Enrollment</p>
<p>Multi select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>HIV/AIDS Care Types</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Enrollment</p>
<p>Multi select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>Patient Referred</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Family Information</p>
<p>Select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>HIV Care Status</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Family Information</p>
<p>Select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>Patient Relation Type</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:51px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:51px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:51px; padding:4px; border:solid 1px #000000;"><p>IE</p>
<p>Multi select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:51px; padding:4px; border:solid 1px #000000;"><p>Presenting Complaint(s)</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:51px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:51px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:51px; padding:4px; border:solid 1px #000000;"><p>IE</p>
<p>ART FU</p>
<p>Non ART FU</p>
<p>Multi select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:51px; padding:4px; border:solid 1px #000000;"><p>OI or AIDS Defining Illness</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:51px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:51px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:51px; padding:4px; border:solid 1px #000000;"><p>IE</p>
<p>ART FU</p>
<p>Select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:51px; padding:4px; border:solid 1px #000000;"><p>Therapy Change Code (Change/Stop regimen reason code)</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:51px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:51px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:51px; padding:4px; border:solid 1px #000000;"><p>ART FU</p>
<p>Multi select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:51px; padding:4px; border:solid 1px #000000;"><p>Adherence Codes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:68px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:68px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:68px; padding:4px; border:solid 1px #000000;"><p>ART FU</p>
<p>Multi select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:68px; padding:4px; border:solid 1px #000000;"><p>ARV Side Effects</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:68px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:68px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:68px; padding:4px; border:solid 1px #000000;"><p>Adult Pharmacy</p>
<p>Paediatric Pharmacy</p>
<p>Multi select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:68px; padding:4px; border:solid 1px #000000;"><p>ARV Providers</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:68px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:68px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:68px; padding:4px; border:solid 1px #000000;"><p>Pharmacy</p>
<p>Select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:68px; padding:4px; border:solid 1px #000000;"><p>HIV Care Type</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:68px; padding:4px; border:solid 1px #000000;"><p>Restricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:68px; padding:4px; border:solid 1px #000000;"><p>A</p>
</td>
<td style="vertical-align:middle; width:151px; height:68px; padding:4px; border:solid 1px #000000;"><p>Care Ended</p>
<p>Select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:68px; padding:4px; border:solid 1px #000000;"><p>Stopped Reason</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:13px; background-color:#e0e0e0; padding:4px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:middle; width:73px; height:13px; background-color:#e0e0e0; padding:4px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:middle; width:151px; height:13px; background-color:#e0e0e0; padding:4px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:middle; width:277px; height:13px; background-color:#e0e0e0; padding:4px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Unrestricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A,I,U</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Enrollment</p>
<p>Care Tracking</p>
<p>Select list </p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>LPTF Patient Transfer</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Unrestricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A, I, U</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Enrollment</p>
<p>Select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>Village/Town/City Name</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Unrestricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A, I, U</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Enrollment</p>
<p>Select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>District/County/ Ward</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Unrestricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A, I, U</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Enrollment</p>
<p>Select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>Province/ State</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:34px; padding:4px; border:solid 1px #000000;"><p>Unrestricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:34px; padding:4px; border:solid 1px #000000;"><p>A, I, U</p>
</td>
<td style="vertical-align:middle; width:151px; height:34px; padding:4px; border:solid 1px #000000;"><p>Enrollment</p>
<p>Select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:34px; padding:4px; border:solid 1px #000000;"><p>Emergency Contact Relationship</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Unrestricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A, I, U</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Enrollment</p>
<p>Radio button</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>Marital Status</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Unrestricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A, I, U</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Enrollment</p>
<p>Select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>Educational Level</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Unrestricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A, I, U</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Enrollment</p>
<p>Select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>Employment Status</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:34px; padding:4px; border:solid 1px #000000;"><p>Unrestricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:34px; padding:4px; border:solid 1px #000000;"><p>A, I, U</p>
</td>
<td style="vertical-align:middle; width:151px; height:34px; padding:4px; border:solid 1px #000000;"><p>All forms</p>
<p>(Displayed as part of employee name, provider, etc.)</p>
</td>
<td style="vertical-align:middle; width:277px; height:34px; padding:4px; border:solid 1px #000000;"><p>Employee Designation </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Unrestricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A, I, U</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>System</p>
<p>Select list categorized by Employee Designation</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>Employee Name</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Unrestricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A, I, U</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>IE (Long Term Medications</p>
<p>and Sulfa drugs)</p>
<p>&nbsp;</p>
<p>Adult and Ped Pharmacy</p>
<p>(OI Treatment and Other Medications)</p>
<p>&nbsp;</p>
<p>Dialog with as-you-type search capability</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>Other Mediation – Drug Master</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Unrestricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A, I, U</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>System</p>
<p>Select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>Scheduler – Appointment purpose</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Unrestricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A, I, U</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Laboratory</p>
<p>Select list or Dialog with as-you-type search capability</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>Additional Labs</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Unrestricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A, I, U</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Laboratory Configuration found in the Customize List section</p>
<p>Select list</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>Laboratory Units</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Unrestricted</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>A, I, U</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Care Tracking</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>LPTF Transferred To</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:middle; width:87px; height:17px; padding:4px; border:solid 1px #000000;"><p>Does not apply</p>
</td>
<td style="vertical-align:middle; width:73px; height:17px; padding:4px; border:solid 1px #000000;"><p>I, U</p>
</td>
<td style="vertical-align:middle; width:151px; height:17px; padding:4px; border:solid 1px #000000;"><p>Laboratory</p>
<p>Units – non editable field</p>
<p>Boundary values for test results for field level validation</p>
</td>
<td style="vertical-align:middle; width:277px; height:17px; padding:4px; border:solid 1px #000000;"><p>Configure Lab Units</p>
</td>
</tr>
</table>
</div>
<p>&nbsp;</p>
<p>&nbsp;</p>
<p>&nbsp;</p>

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